Male Involvement is Key
to Reproductive Health
I. The Issues
II. What is "male involvement"?
Despite many advances in overall health,
reproductive health in Cambodia could be
improved. Family planning and reproductive
health are often portrayed as women's
responsibilities, few male contraceptive methods
are available, and RH services are typically
provided through MCH programs. Similarly,
providers often fail to include partners when
serving female clients especially when they have
problems relating to RH. Moreover, the MCH
training curriculum, for health promotion as well
as for clinic at care, does not include male
responsibility. More importantly, the Ministry of
Health's Strategic Plan does not include indicators
on men such as number of partner referrals at STI
clinics, number of services available to men at
MCH clinics, etc.
Around the world, men play critical roles in
women's ability to seek health care, yet, more
often than not, they are uninformed about
women's reproductive health needs or their own.
The word "Reproductive Health" implies both
men and women. Men are partners in reproduction
and sexuality. Men's reproductive health and their
behaviors impact on women's reproductive health
and children's well-being and society as well.
Comprehensive male involvement includes:
1. Encouraging men to become more involved and
supportive of women's needs, choices, and rights
in sexual and reproductive health; and
2. Addressing men's own sexual and reproductive
health needs and behaviour.
It is believed that when male and
female aware of each other's health
needs, they are more likely to
receive needed services.1
Involving men will be important to achieving
Cambodia's Millennium Development Goals.2
"Special efforts should be made
to emphasize men's shared responsibility and promote their active
involvement in responsible parenthood, sexual and reproductive
behaviour (ICPD)"3
In Cambodia, many decisions - including
decisions about whether and when to seek health
care - are made by men. This is one of the major
causes of having gender inequity in reproductive
health. The 1994 International Conference on
Population and Development (ICPD) held in Cairo,
Egypt called for male involvement in reproductive
health programs to overcome gender inequities
and improve the health of both men and women.4
III. Reproductive Health in Cambodia
Overall, reproductive health has improved in
Cambodia in recent years. Still, there is room for
improvement:
• The fertility rate is high at 4.0 children per
woman.5
• 81% of married couples do not use any modern
methods of contraception6. 30% of these
married women want to use any contraception
method but they do not have access to it
(unmet needs).
• Each year, over 1,800 Cambodian women and
girls die during pregnancy or childbirth, and
tens of thousands suffer from complications7.
Increasing contraceptive prevalence is closely
associated with decreasing maternal mortality.
• The death of a mother significantly increases a
child's risk of death and illness, and reduces his
or her access to education and proper nutrition.
Almost one in ten babies born in Cambodia will
not live to celebrate his or her first birthday.8
• 55% of mothers do not receive ante-natal care
and two-thirds of births occur with out a
trained provider presents9. 89% of births still
take place at home, where life saving equipment
and facilities are not available if a problem
emerges.10
• Cambodia has one of the region's highest HIV
prevalence rates among people aged 15-49
(2.6%11). Transmission from husband to wife
accounts for 42% of all new infections.12
IV.Cambodian Government Millennium
Development Goals (MDGs) for 2015
• Reduce the maternal mortality ratio from 437
to 140 per 100,000 live births.
• Ensure 80% of all births are attended by trained
personnel.
• Achieve 60% of all married women using
modern contraceptives.
• Ensure 90% of pregnant women attend 2 or
more ante-natal consultations.
• Reduce the total fertility rate from 4.0 to 3.0.
V. How can male involvement improve
reproductive health in Cambodia and help
the government achieve its MDG targets?
The Programme of Action from the 1994
International Conference on Population
and Development (ICPD) urges all
countries to provide men, as well as
women, with reproductive health care
that is "accessible, affordable,
acceptable, and convenient.
Considerable evidence from Cambodia and
elsewhere has shown the benefits of involving
male in reproductive health.
A.
Male involvement programs have
improved family health in Cambodia
• The Ministry of Women Affairs (MoWA)
conducted pilot projects in 2000-2003 on male
involvement in Thmo Koal district of
Battambang province and in Svay Rieng
district of Svay Rieng province to improve the
reproductive health status of people in the
project's areas. The projects led to an increase
in contraceptive demand compared to other
districts.13
Men discuss about
using family
planning methods
Photo: MoWA
• HIV sero-prevalence seems to have dropped
significantly among Cambodia's urban police,
due in large part to active condom promotion
efforts by governmental and non-governmental
organizations 14. The Ministry of Health
estimates that this effort prevented HIV
prevalence from reaching 3 times its current
level.
• Since 1996, RHAC has broadened its focus to
include both men and women. Since that time,
health education, counselling, care and
treatment services have been provided to men
and women, individuals and partners. Male
clients seeking STI services increased from 1%
(before 1996) to 13% by 2004. For permanent
contraceptive acceptors 57% are men. This is a
clear proof that programs designed to focus on
both men and women encourage better male
involvement. Through this approach men
contribute to preventing the spread of HIV/AIDS
and reducing maternal and infant mortality.15
Men clients receive
information about
reproductive health
Photo: RHAC
• The Voluntary Surgical Contraception (VSC)
projects supported by Racha had been
implemented in 17 referral hospitals since
1997. Since early 2000, VSC projects have been
focussing on leaders, authorities, and health
center staff who are mosly men. There had
been significant increased of vasectomy
acceptors in which 28% are men. So, providing
information to both men and women increases
men participation in reproductive health which
improves family health and social well-being.16
• The result of the "Working with Men, Responding
to AIDS in Cambodia" projects of KHANA that
have been implemented by 17 organizations
throughout the country in 2003-2004 showed
that more men and women are going for STI
treatment. there is greater demand for condoms
use.17
“Talking together
in small groups
can
help
men
developing skills
and confidence to
overcome barriers
to HIV prevention.
It can also help to
change community
attitudes towards
safer sex.”
rUbPaB³ KHANA
• The Playing Safe pilot project implemented by
CARE & GAD/C and Youth Department (MoEYS)
aims to reach 20,000 young males in Phnom
Penh before the end of 2005. Some unique
features of the project include its focus upon
youth empowerment and it's a rights-based
approach to health. Many young participants
have adopted safer and more responsible
sexual behaviours, and have a better
understanding of the need for consent within
sexual activity.18
Young male discuss
about
reproductive health
Photo:
Playing Safe Project
• Marie Stopes Cambodia has clinics and
outreach activities providing reproductive
health and birth spacing services for both men
and women. Strategically, the organization tries
its best to encourage male clients and partners
to come for services. As result, the male clients
increased from 1.06% in 2003 to 2.63% in 2004.19
clinic visits and lower perinatal mortality among
the women whose husbands received antenatal
education21. More recently, an intervention
during prenatal consultations to increase men's
involvement in their partners' maternal care
increased couples' discussion and use of
contraception and improved knowledge about
pregnancy and family planning.22
• Research in Egypt has shown that involving men
in post-abortion care significantly decreases
women's recovery time and their likelihood of
using contraception.23
• Research shows that married women's greatest
risk factor for STIs is the sexual behaviour of
their husbands. Cross-sectional case-control
study in Kenya showed that HIV transmission
was threefold lower among women whose
husband or usual sex partner was circumcised
or usually used condom when having multiple
sex partners.24
• Fathers' involvement in the lives of their
children has been shown to have lasting effects.
Program data from Jamaica, Zimbabwe and
Vietnam show that children with actively
involved fathers have higher self-esteem,
higher educational achievement, and tend to be
more successful. Increased involvement of men
in childcare also contributes to greater equality
between men and women.25
VI.Recommendations
Male police practice
using a condom
Photo: MSC
B. Evidence from other countries
Many studies have shown positive health effects
when male partners or husbands have attended
health education or counselling sessions on
HIV/AIDS prevention, family planning, ante-natal
care, and nutrition.
• Randomized trials in Turkey, Ethiopia, and
China have found that contraceptive adoption
was significantly higher among women whose
husbands were included in contraceptive
counselling compared to women whose
husbands were not involved.20
• A study on the impact of providing ante-natal
education to prospective fathers in India found
a significantly higher frequency of ante-natal
To ensure increased male involvement in health
issues especially reproductive health, relevant
institutions could take various steps to:
1. Learn more about what Cambodian men and
women know, think and need where men's
sexual and reproductive roles are concerned.
2. Design more reproductive health programs that
involve men and educate them about sexual
andreproductive health, their own responsibilities,
and that address men's own needs.
3. Seek out opportunities to support male
involvement through reproductive health norms
and regulations.
4. Work with Ministry of Health and nongovernmental organizations to develop
guidelines on male involvement in reproductive
health.
5. Provide technical and financial assistance to the
Ministry of Health for the development of
guidelines on men's involvement in reproductive
health.
18
CARE and GAD/C: Playing Safe project 2004, Available at
www.playsafe.info
Cambodia Millennium Development Goals (CMDGs) Report 2003
19
MSC: Activity Report 2003 & 2004.
3
International Conference on Population and Development (ICPD),
Cairo, Egypt 1994: Frameworks on Male Involvement in
Reproductive Health.
20
4
International Conference on Population and Development (ICPD),
Cairo, Egypt 1994: Frameworks on Male Involvement in
Reproductive Health.
5
Cambodia Demographic and Health Survey (CDHS) 2000
6
CDHS 2000
Fisek Nh., Sumbulogly K., 1978. “The effects of husband and wife
education on family planning in rural Turkey.” Studies in Family
Planning 9 (10-11): 280-285; Terefe A; Larson CP. 1993. “Modern
contraception use in Ethiopia: does involving husbands make a
difference?” American Journal Of Public Health Nov;83(11):1567-71;
Wang, CC, E. Vittinghoff, SH Lu, HY Wang HY, and MR Zhou. 1998.
“Reducing pregnancy and induced abortion rates in China: family
planning with husband participation.” American Journal Of Public
Health. Apr;88(4):646-8; Raju, S and A Leonard. 2000. Men As
Supportive Partners In Reproductive Health: Moving From Rhetoric
To Reality. New Delhi, India, Population Council, South and East
Asia Regional Office.
7
CDHS 2000
21
8
CDHS 2000
9
CMDG Report 2003
Bhalerao VR; Galwankar M; Kowli SS; Kumar R; Chaturvedi RM.
Contribution of the education of the prospective fathers to the
success of maternal health care programme. Journal of
Postgraduate Medicine 1984 Jan, 30(1):10-2.
10
CDHS 2000
22
11
NCHADS report 2002; NAA report 2003; UNAIDS 2004. UNAIDS 2004
Report on the global AIDS epidemic 2004.
Varkey, Leila Caleb, Anurag Mishra, Anjana Das, Emma
Ottolenghi, Dale Huntington, Susan Adamchak, and M.E. Khan.
2004. “Involving Men in Maternity Care in India,” FRONTIERS Final
Report. Washington, DC: Population Council. Available at
http://www.popcouncil.org/pdfs/frontiers/FR FinalReports/Indi MIM.pdf
12
NAA 2003
23
13
Ministry of Women and Veteran Affair (MoWA): Pilot projects on
RH with focusing on both men & women, 2000-2003.
Huntington D, Nawar L, Abdel Hady, D. An Exploratory Study of
the Psycho-social Stress Associated with Abortions in Egypt: Final
Report. Cairo: The Population Council, 1995.
14
UNAIDS. 2003. AIDS Epidemic Update: December 2003
15
RHAC's statistic report
16
Racha: Voluntary Surgical Contraception Project report 2004.
17
KHANA: Working with Men, Responding to AIDS in Cambodia
project 2003-2004.
1
Population Reference Bureau (PRB)
2
Hunter DJ, BN Maggwa, JK Mati, PM Tukei, and S Mbugua. 1994.
“Sexual Behavior, Sexually Transmitted Diseases, Male Circumcision
and Risk of HIV Infection Among Women in Nairobi, Kenya." AIDS.
Jan;8(1):93-9.
24
25
Brase M; Dinglasan R; Ho M; Kail N; Katz R; Lopez V; Ton TG.
1997. “UNICEF - Yale School of Public Health research project: The
role of men in families.” New Haven, Connecticut, Yale University
School of Medicine, International Health Dept.154 p.
Reproductive Health Promotion Working Group (RHPWG)
6
In October 2003, MEDiCAM established a Reproductive Health Promotion Working Group
(RHPWG). The members of the Working Group are from the MEDiCAM NGOs network, and
actively work in the area of reproductive health in Cambodia. At the moment, there are 14
organizations: RHAC, Racha, ADRA, CARE, WCRD, TASK, MSC, WDA, POLICY Project, CAPPD, URC,
PSI, CPN+, and MEDiCAM itself. UNFPA is one of the main supporting agencies to the RHPWG. In
November 2003, the RHPWG met together for the first time with support from the POLICY
Project to analyze the barriers in reproductive health. At present, the RHPWG is advocating
"Male Involvement in reproductive health" as a priority issue.
October 2004
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